Steroids in STEMI Patients: Recommendations and Contraindications

Risks of Steroid Use in STEMI

The American College of Cardiology and Circulation guidelines recommend avoiding glucocorticoids for treatment of pericarditis after STEMI, as they are potentially harmful 1

Morphine sulfate is the drug of choice for pain relief in patients with STEMI, especially those whose course is complicated by acute pulmonary edema 2
Acetaminophen is recommended if additional pain control is needed, at 500 mg orally every 6 hours 1
Colchicine 0.6 mg every 12 hours orally can be added for cases with pericarditis not adequately controlled with aspirin alone 1
The American College of Cardiology notes that administration of acetaminophen, colchicine, or narcotic analgesics may be reasonable if aspirin is not effective 3

NSAIDs and COX-2 inhibitors are contraindicated in patients with STEMI and should not be administered during hospitalization 4, 2
NSAIDs are associated with increased risk of death, reinfarction, cardiac rupture, hypertension, heart failure, and myocardial rupture 4, 5
Aspirin is the primary anti-inflammatory treatment recommended for STEMI patients 1

For hemodynamically unstable patients with cardiogenic shock, emergency revascularization with either PCI or CABG is recommended regardless of time delay from MI onset 3
Intra-aortic balloon pump counterpulsation can be useful for patients with cardiogenic shock who do not quickly stabilize with pharmacological therapy 3
Beta blockers should be initiated within the first 24 hours in patients without contraindications such as signs of heart failure, low-output state, or increased risk for cardiogenic shock 3
ACE inhibitors should be administered within the first 24 hours to all patients with anterior STEMI, heart failure, or ejection fraction ≤0.40 3